Father's Name:

PARENTAL CONSENT

I, being the parent or legal guardian of the student named above, do consent to the participation of the student in all of the activities sponsored by Fond du Lac Area Youth for Christ, Campus Life, The Union, or Fresh Start from this date forward.  This includes all trips and activities associated with these groups.  I certify that the student is physically fit to participate in such event (except as noted).  Please check one of the boxes below.

PUBLICATION RELEASE

Is Youth for Christ given permission to use name, still photograph, video, or any reproduced likeness of said student for any promotional publications, advertising, or educational presentations sponsored by their organization?

Does your student have any other allergies? (List below)

I understand that I will be notified in case of medical emergency involving the student.  However, in the event that I cannot be reached, I authorize an adult sponsor of Youth for Christ (paid or volunteer) to secure and consent to such medical, dental, psychological and /or surgical treatment deemed necessary for the treatment of an accident or illness.  I understand that YFC/Campus Life/The Union/Fresh Start, will not be responsible for medical expenses incurred, but that such expenses will be my responsibility as parent/gaurdian.  I agree to notify Fond du Lac Area Youth for Christ office in the event of any health changes, which would restrict the student's participation in any normal activities.  I also understand that the adult supervisors reserve the right to restrict the student from any activity that they do not feel is within the physical capabilities of the student.